Superiority of escitalopram to paroxetine in the treatment of depression

Post-hoc pooled analysis of data from two 6-month randomised controlled trials in patients with major depressive disorder (MDD) revealed superior efficacy and tolerability of escitalopram when compared with paroxetine. Escitalopram (n=394) produced a significantly (p<0.01) greater mean treatment difference of 2.0 points in primary endpoints, judged using the Montgomery-Asberg Depression Rating Scale (MADRS) total score, compared with paroxetine (n=383). Significant differences were also observed in Clinical Global Impression (CGI)--severity (escitalopram, 2.1; paroxetine, 2.4; p<0.01) and CGI--improvement (escitalopram, 1.8; paroxetine, 2.0: p<0.01). In the sub-group of severely depressed patients (baseline MADRS> or = 30), escitalopram showed further improved efficacy compared with paroxetine in all scores. This analysis supports previous observations of superior efficacy and tolerability of long-term escitalopram treatment (10 to 20 mg/day) compared with paroxetine (20 to 40 mg/day). Escitalopram is a good therapeutic option for the long-term treatment of MDD, particularly in severely depressed patients.

[1]  J. Boulenger.  Residual symptoms of depression: clinical and theoretical implications , 2004, European Psychiatry.

[2]  M. Thase.  Comparing the methods used to compare antidepressants. , 2002, Psychopharmacology bulletin.

[3]  George Davey Smith,et al.  Meta-analysis: Principles and procedures , 1997, BMJ.

[4]  M. Trivedi,et al.  Effectiveness of low doses of paroxetine controlled release in the treatment of major depressive disorder. , 2004, The Journal of clinical psychiatry.

[5]  M. Sarchiapone,et al.  A comparative study of the efficacy of long-term treatment with escitalopram and paroxetine in severely depressed patients , 2006, Current medical research and opinion.

[6]  I. Hindmarch,et al.  A double-blind, randomized, parallel-group, flexible-dose study to evaluate the tolerability, efficacy and effects of treatment discontinuation with escitalopram and paroxetine in patients with major depressive disorder , 2006, International clinical psychopharmacology.

[7]  Alan Wade,et al.  Do equivalent doses of escitalopram and citalopram have similar efficacy? A pooled analysis of two positive placebo-controlled studies in major depressive disorder , 2004, International clinical psychopharmacology.

[8]  K. Bogeso,et al.  Escitalopram versus citalopram: the surprising role of the R-enantiomer , 2004, Psychopharmacology.

[9]  Blair T. Johnson,et al.  Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration , 2008, PLoS medicine.

[10]  C. Sánchez.  The pharmacology of citalopram enantiomers: the antagonism by R-citalopram on the effect of S-citalopram. , 2006, Basic & clinical pharmacology & toxicology.

[11]  U. Lepola,et al.  Escitalopram (10–20 mg/day) is effective and well tolerated in a placebo‐controlled study in depression in primary care , 2003, International clinical psychopharmacology.

[12]  L. Colonna,et al.  A randomized, double-blind, 24‐week study of escitalopram (10 mg/day) versus citalopram (20 mg/day) in primary care patients with major depressive disorder* , 2005, Current medical research and opinion.

[13]  N. Moore,et al.  Prospective, multicentre, randomized, double-blind study of the efficacy of escitalopram versus citalopram in outpatient treatment of major depressive disorder , 2005, International clinical psychopharmacology.

[14]  Siegfried Kasper,et al.  Escitalopram in the Long-Term Treatment of Major Depressive Disorder in Elderly Patients , 2007, Neuropsychobiology.

[15]  U. Lepola,et al.  Escitalopram 10 mg/day is effective and well tolerated in a placebo-controlled study in depression in primary care , 2002, International clinical psychopharmacology.

[16]  M. Thase.  The next step forward: a move toward evidence, and away from fear of the industry. , 2002, Psychopharmacology bulletin.

[17]  I. Kirsch,et al.  The Emperor's New Drugs: An Analysis of Antidepressant Medication Data Submitted to the U.S. Food and Drug Administration , 2002 .

[18]  Rupert Lanzenberger,et al.  Higher serotonin transporter occupancy after multiple dose administration of escitalopram compared to citalopram: an [123I]ADAM SPECT study , 2007, Psychopharmacology.

[19]  Naomi A. Fineberg,et al.  Which antidepressants have demonstrated superior efficacy? A review of the evidence , 2007, International clinical psychopharmacology.

[20]  U. Lepola,et al.  Escitalopram 10 mg/day is effective and well tolerated in a placebo-controlled study in depression in primary care. , 2003 .

[21]  C. Nemeroff,et al.  Efficacy and tolerability of controlled-release and immediate-release paroxetine in the treatment of depression. , 2002, The Journal of clinical psychiatry.

[22]  A. G. Casswell.  A COMPARATIVE STUDY OF THE EFFICACY OF , 1996 .

[23]  G. Smith,et al.  Meta-analysis: Potentials and promise , 1997, BMJ.

[24]  C. Sánchez,et al.  Allosteric modulation of the effect of escitalopram, paroxetine and fluoxetine: in-vitro and in-vivo studies. , 2007, The international journal of neuropsychopharmacology.

[25]  S. Kasper.  Unique mechanism of action for escitalopram: does it hold the promise? , 2004, International journal of psychiatry in clinical practice.

[26]  J. Füredi,et al.  Predictors for 2-year outcome of major depressive episode. , 2004, Journal of affective disorders.

[27]  G. Alexopoulos,et al.  Double-Blind Comparison of Escitalopram and Duloxetine in the Acute Treatment of Major Depressive Disorder , 2007, Clinical drug investigation.